Evaluating a subrogation potential of an insurance claim

ABSTRACT

A method, system and computer program product for evaluating a subrogation potential of a target insurance claim is disclosed. A peer group of claims that are expected to include similar behaviors as the target claim and have been successfully subrogated is established to determine a normal behavior that the target claim is supposed to include. A behavior of the target claim is compared to the normal behavior to evaluate a subrogation potential of the target claim. Proper subrogation solutions are prospectively chosen based on the determined normal behavior to increase efficiency.

FIELD OF THE INVENTION

The invention relates generally to a subrogation of an insurance claim,and more particularly to an evaluation of a subrogation potential of aninsurance claim.

BACKGROUND OF THE INVENTION

In the operation of an insurance business, the processing of claimfunction is a key to the financial performance and the customersatisfaction of the business. For example, in the case of homeinsurance, the claim function provides payment to an insured homeownerif a loss is incurred to the homer. As is understandable, a quick,reasonable payment will make the insured homeowner satisfactory, whichmay increase credibility and reliability of the insurance business. Onthe other hand, avoidance of an unreasonable or unwarranted payment tothe insured homeowner will increase the financial solidity of theinsurance business.

A common process of an insurance company to avoid unreasonable orunwarranted claim payments is referred to as subrogation, whichidentifies situations where a third party may share in theresponsibility for an insured loss. For example, if a hot water heaterleaks and floods an insured real estate, the insurance company needs topay for the damage. However, if the insurance company identifiesthrough, e.g., subrogation, that the hot water heater leakage is causedby manufacturing defects, the manufacturer may also be liable for theloss, which reduces the claim cost of the insurance company and alsokeeps the insurance cost of the homeowner from rising.

Regarding subrogation, an insurance company often finds itself in adilemma. Attempting to subrogate all claims would be excessivelyexpensive and time consuming, whereas missing an opportunity of sharingresponsibility would unduly increase claim cost. For most insurancecompanies, claim costs constitute approximately 80 percent of the costsincurred in the operation, which has a significant impact to theinsurance companies.

Based on the above, it is preferable that an insurance company canidentify claims that have a high potential for subrogation to conductsubrogation selectively. The existing technology does not provide asuccessful solution to this question. As such, there is need forevaluating a subrogation potential of an insurance claim.

BRIEF SUMMARY OF THE INVENTION

A method, system and computer program product for evaluating asubrogation potential of a target insurance claim is disclosed. A peergroup of claims that are expected to include similar behaviors as thetarget claim and have been successfully subrogated is established todetermine a normal behavior that the target claim is supposed toinclude. A behavior of the target claim is compared to the normalbehavior to evaluate a subrogation potential of the target claim. Propersubrogation solutions are prospectively chosen based on the determinednormal behavior to increase efficiency.

A first aspect of the invention is directed to a method for evaluating asubrogation potential of a target claim for insurance payment, themethod comprising steps of: selecting a peer group of claims that areexpected to include a similar behavior as the target claim and have beensuccessfully subrogated; identifying a set of behavioral attributes ofthe peer group; determining a normal behavior of the peer groupregarding the identified set of behavioral attributes; and comparing abehavior of the target claim to the normal behavior regarding theidentified set of behavior attributes to evaluate the subrogationpotential of the target claim.

A second aspect of the invention is directed to a system for evaluatinga subrogation potential of a target claim for insurance payment, thesystem comprising: means for selecting a peer group of claims that areexpected to include a similar behavior as the target claim and have beensuccessfully subrogated; means for identifying a set of behavioralattributes of the peer group; means for determining a normal behavior ofthe peer group regarding the identified set of behavioral attributes;and means for comparing a behavior of the target claim to the normalbehavior regarding the identified set of behavior attributes to evaluatethe subrogation potential of the target claim.

A third aspect of the invention is directed to a computer programproduct for evaluating a subrogation potential of a target claim forinsurance payment, the computer program product comprising: computerusable program code configured to: select a peer group of claims thatare expected to include a similar behavior as the target claim and havebeen successfully subrogated; identify a set of behavioral attributes ofthe peer group; determine a normal behavior of the peer group regardingthe identified set of behavioral attributes; and compare a behavior ofthe target claim to the normal behavior regarding the identified set ofbehavior attributes to evaluate the subrogation potential of the targetclaim.

A fourth aspect of the invention is directed to a method of generating asystem for evaluating a subrogation potential of a target claim forinsurance payment, the method comprising: providing a computerinfrastructure operable to: select a peer group of claims that areexpected to include a similar behavior as the target claim and have beensuccessfully subrogated; identify a set of behavioral attributes of thepeer group; determine a normal behavior of the peer group regarding theidentified set of behavioral attributes; compare a behavior of thetarget claim to the normal behavior regarding the identified set ofbehavior attributes to evaluate the subrogation potential of the targetclaim; and communicate a result of the evaluation to a customerinsurance company.

Other aspects and features of the present invention, as defined solelyby the claims, will become apparent to those ordinarily skilled in theart upon review of the following non-limited detailed description of theinvention in conjunction with the accompanying figures.

BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS

The embodiments of this invention will be described in detail, withreference to the following figures, wherein like designations denotelike elements, and wherein:

FIG. 1 shows a schematic view of an illustrative insurance claimsubrogating system according to one embodiment of the invention.

FIG. 2 shows a block diagram of an illustrative computer systemaccording to one embodiment of the invention

FIG. 3 shows a flow diagram of one embodiment of the operation of aclaim subrogation potential evaluating system according to theinvention.

FIG. 4 shows an illustrative example of a hierarchical structure ofclaim attributes according to the invention.

FIG. 5 shows an illustrative example of a data table of behavioralattributes and subrogation solutions according to one embodiment of theinvention.

DETAILED DESCRIPTION OF THE INVENTION

The following detailed description of embodiments refers to theaccompanying drawings, which illustrate specific embodiments of theinvention. Other embodiments having different structures and operationsdo not depart from the scope of the present invention.

1. System Overview

Referring to FIG. 1, a schematic view of an illustrative insurance claimsubrogating system 10 is shown. According to one embodiment, subrogatingsystem 10 includes a claim subrogation processing center 12 including acomputer system 100 and a claim subrogation implementation unit 200; andmultiple investigating units 14 (two are shown). Investigating units 14collect information regarding claim 16, including, for example, time ofloss, time of report, type of loss, type of claim, actions taken byclaimant 16, etc. Investigating units 14 may include any persons ordevices employed by an insurance company for investigating an insuranceclaim regarding issues that are related to the processing of the claimby the insurance company. For example, investigating units 14 may be aninvestigator who is employed by an insurance company and works toinvestigate issue related to the processing of a claim. A claimappraiser may also be a convenient candidate to perform the functions ofinvestigating units 14. According to one embodiment, investigating units14 may also conduct a claim subrogation process according to theinstructions of claim subrogation implementation unit 200 and mayfeedback the outcomes of the subrogation process to computer system 100.For example, investigating units 14 may communicate to computer system100 whether they successfully find a third party to share responsibilitythrough the claim subrogation process.

Claim/claimant 16 may communicate with processing center 12 regarding,for example, loss and claim information, for example, time of loss, typeof loss, any measures taken to reduce loss, amount of loss, and thecontext of the loss. Claimant 16 may also communicate with investigatingunits 14 in the process of data collecting. For example, claimant 16 maybe interviewed by investigating unit 14 regarding the context of theloss and measures taken to reduce loss, and may be requested to providepolice reports, product warranty documents, or other information thatcan be used in the investigation.

According to one embodiment, in the following description of subrogationsystem 10, a claim and a claimant are taken as matching one-to-one toeach other. Specifically, in subrogation system 10, a claim is always aclaimant's claim, and a claimant is always a claim's claimant. If anindividual submits two claims, the individual is treated as twoclaimants regarding the two claims. If a claim has more than onebeneficiaries, e.g., joint beneficiaries, the more than onebeneficiaries are treated as one claimant for simplicity purpose. Assuch, in FIG. 1, a claim and a claimant are similarly marked as 16. Insubrogating system 10, a target claim 16 is generally a claim 16.However, for illustrative purpose, in the following description, a claim16 is referred to as a target claim 16 when this claim 16 is processedby claim subrogation processing center 12, i.e., when this specificclaim 16 is evaluated regarding a subrogation potential. Similarly, theclaimant of target claim 16 is referred to as target claimant 16, forillustrative purpose only. It should be noted that in subrogating system10, regardless of whether a claim 16 is a target claim 16, dataregarding the claim 16 will be collected because: (a) any claim maypotentially become a target claim, and (b) any claim may potentially beselected into a peer group as described later.

In operation, claim 16 submitted from claimant 16 may be communicated tocomputer system 100 of processing center 12 to evaluate whether theclaim has potential of subrogation. If computer system 100 obtains apositive evaluation result, i.e., the claim has potential ofsubrogation, the evaluation result will be communicated to claimsubrogation implementation unit 200 to implement a subrogation process.Details of computer system 100 of processing center 12 will be describedbelow.

2. Computer System

Referring to FIG. 2, a block diagram of an illustrative computer system100 according to the present invention is shown. In one embodiment,computer system 100 includes a memory 120, a processing unit (PU) 122,input/output devices (I/0) 124 and a bus 126. A database 128 may also beprovided for storage of data relative to processing tasks. Memory 120includes a program product 130 that, when executed by PU 122, comprisesvarious functional capabilities described in further detail below.Memory 120 (and database 128) may comprise any known type of datastorage system and/or transmission media, including magnetic media,optical media, random access memory (RAM), read only memory (ROM), adata target, etc. Moreover, memory 120 (and database 128) may reside ata single physical location comprising one or more types of data storage,or be distributed across a plurality of physical systems. PU 122 maylikewise comprise a single processing unit, or a plurality of processingunits distributed across one or more locations. I/O 124 may comprise anyknown type of input/output device including a network system, modem,keyboard, mouse, scanner, voice recognition system, CRT, printer, discdrives, etc. Additional components, such as cache memory, communicationsystems, system software, etc., may also be incorporated into computersystem 100.

As shown in FIG. 2, program product 130 may include a claim subrogationpotential evaluating system 132 that includes a data collector 140; anormal behavior determinator 142 including a sampler 144, a behavioralattribute identifier 145 and an analyzer 146; a subrogation potentialevaluator 148 including a comparator 150 and a combiner 152; a suspectbehavior detector 154; a prospective subrogation potential investigator156; and other system components 158. Other system components 158 mayinclude any now known or later developed parts of a computer system 100not individually delineated herein, but understood by those skilled inthe art.

Inputs to computer system 100 include investigating inputs 160, operatorinputs 162 and claimant inputs 164. Investigating inputs 160 include thedata collected by investigating units 14 (FIG. 1). Operator inputs 162include instructions of an operator of computer system 100 regarding theoperation of, inter alia, claim subrogation potential evaluating system132, as will be described in detail below. Claimant inputs 164 includeinformation regarding claim 16 that is reported by claimant 16 (FIG. 1).Those inputs may be communicated to computer system 100 through I/O 124and may be stored in database 128. Outputs of computer system 100include evaluating result outputs 166 that are communicated to, interalia, claim subrogation implementation unit 200 for it to actaccordingly. The information provided by investigating units 14 throughinvestigating inputs 160 and by claimants 16 through claimant inputs 164might overlap and the contradict. In this situation, the informationfrom investigating units 14 is relied by claim subrogation potentialevaluating system 132 in evaluating a subrogation potential of targetclaim 16 because investigating units 14 are supposed to be more reliablethan claimants 16 regarding a claim submitted. In addition, a divergencebetween the information provided by investigating units 14 and claimant16 may be used to detect an abnormal behavior of the claim submitted byclaimant 16 in a prospective analysis of claim subrogation potentialevaluating system 132, as will be described later. The operation ofclaim subrogation potential evaluating system 132 will be described indetails below.

3. Claim Subrogation Potential Evaluating System

Claim subrogation potential evaluating system 132 functions generally toevaluate whether a claim has the potential of subrogation, i.e., aprocess to identify whether a third party may share the responsibilityfor the claimed loss. One embodiment of the operation of claimsubrogation potential evaluating system 132 is shown in the flow diagramof FIG. 3.

According to one embodiment, the operation of claim subrogationpotential evaluating system 132 includes a historic analysis and aprospective analysis. Referring also to FIG. 1, the historic analysisoperation occurs usually after investigating units 14 have finished aninvestigation of target claim 16 and obtained all the information neededfor evaluating the subrogation potential of target claim 16. Theprospective analysis operation usually occurs after target claim 16 issubmitted, but before investigating units 14 finish an investigation oftarget claim 16. One objective of the prospective analysis operation isto prospectively detect an abnormality of target claim 16 so thatinvestigating units 14 and/or claim subrogation implementation unit 200may respond accordingly before unnecessary investigations have beenperformed. For example, investigating units 14 may pay more attention tothe information related to the detected abnormality and/or possiblesubrogation solutions related to the abnormality to increase efficiency.An embodiment of the operation of claim subrogation potential evaluatingsystem 132 regarding the historical analysis and the prospectiveanalysis will be shown in the flow diagram of FIG. 3.

Referring now to FIG. 3, with reference also to FIG. 2, according to oneembodiment, the historic analysis is represented by step S200 includingsteps S201 to S203; and the prospective analysis is represented by stepS300 including steps S301 to S302. Specifically, with respect to step200, first in step S201, data collector 140 collects data and organizesthe data to facilitate a further statistical analysis of the data. Thedata collected include those of investigating inputs 160 and claimantinputs 164. Data collector 140 collects data of all claims submitted toan insurance company that employs processing center 12 (FIG. 1). As isdescribed above, investigating units 14 may also conduct subrogationprocess and communicate the results of the subrogation process, e.g.,whether a third party is identified through the subrogation process, tocomputer system 100 through investigating inputs 160. As such, the datacollected may also include subrogation results of claims 16, if asubrogation process had been done with claims 16. Please note, as isunderstandable, there will not be subrogation results informationregarding target claim 16, because target claim 16 has not beensubrogated. According to one embodiment, the data collected include allthe data regarding claim 16 for processing an insurance payment and theadditional data for processing a claim subrogation. For example, thedata may include information regarding the loss of the property, actionstaken after the loss including those taken to reduce further loss,claiming process, and other details of the claim. In the followingdescription, the information collected by data collector 140 will bereferred to as claim attributes, for illustrative purpose only. Theclaim attributes may have continuous data value or categorized datavalue such as “yes/no” or “1/0”. The data value of a claim attribute isreferred to as a behavior regarding the claim attribute in the followingdescription, for illustrative purpose only.

For each specific claim 16 (FIG. 1), claim attribute data might havesome problems such as missing data or obviously strange data. Thoseproblems need to be resolved by data collector 140 in step S201 beforethe problematic data is used for further analysis. Claim attribute datamay also need to be treated in step S201 to fit an analysis purpose. Forexample, in some situations, a categorized type of data might be moresuitable than a data of continuous value, so continuous claim attributedata may need to be converted to categorized data in step S201.

Next in step S202, normal behavior determinator 142 determines a normalbehavior of a peer group of claims 16 that are expected to includesimilar behaviors regarding a certain claim attributes as target claim16 (FIG. 1) and have been successfully subrogated. Specifically, in stepS202 a, sampler 144 establishes/selects a peer group of claims 16, whichare expected to include the same (or similar) behaviors regarding acertain claim attributes and have been successfully subrogated.Generally speaking, definition of a peer group for a specific targetclaim 16 is based on homogeneous or similar behaviors regarding claimattributes among target claim 16 and other claims 16 that have beensuccessfully subrogated. For example, if target claim 16 claims loss ofhousehold property due to hot water heater explosion, other claims (16)of loss of household property due to hot water heater explosion and havebeen successfully subrogated may be selected to constitute the peergroup.

Any claim attribute may be used as the basis to define a peer group ifthe homogeneity in this claim attribute may predict similarity in otherclaim attributes. However, claim attributes that are related to (oraffect) subrogation potential are usually not preferable to define peergroup because behaviors regarding those claim attributes will beanalyzed in the evaluation of subrogation potential of target claim 16.As is understandable, any claim attribute that is used to define a peergroup will not be analyzed among the peer group, because the homogeneityregarding this claim attribute is given. According to one embodiment, aclassification of claims in the insurance company that claim 16 issubmitted to maybe used to define a peer group to facilitate theadministration of the claim processing.

Please note, claim attribute data may be described as a hierarchicalstructure like the illustrative example shown in FIG. 4. As isunderstandable, the more claim attributes are used for defining a peergroup, the more homogeneous the peer group is and the more specific ananalysis is based on the peer group. Referring to the example of FIG. 4,please note, however, the operation of claim subrogation potentialevaluating system 132 can be operated in any tiers of peer groups. Forexample, if a peer group in established in tier 1, i.e., all claims,whether a real estate related claim or a vehicle related claim have morepotential of subrogation may be determined according to the operationdescribed below; if a peer group is established in tier 2 level, e.g.,all real estate claim, whether a fire related real estate damage or aflooding related real estate damage has more potential of subrogationmay be determined. In the following description, claim attributes thatare used to define a peer group are referred to as sampling attributes,for descriptive purpose only.

It should also be noted that the selection of a peer group is conductedby evaluating system 132, specifically sampler 144, independent ofinterventions of claimants 16 (FIG. 1). According to one embodiment, noinformation regarding the peer group selection, for example, standard,procedure, and/or results, will be communicated to claimant 16. This isto ensure that target claimant 16 and other claimants 16 of claims 16that have the possibility of being selected into a peer group will notcoordinate in a fraudulent type of actions, which will be more difficultto detect.

According to one embodiment, in step S202 a, sampler 144 firstidentifies a pool of all the claims 16 based on their homogeneity in thesampling attributes as target claim 16. Next, sampler 144 selects amongthe pool those claims 16 that have already successfully gone throughsubrogation processes (e.g., identified at least one third party that isresponsible for the claimed loss) to generate a modified pool. Accordingto one embodiment, sampler 144 only selects claims 16 that were randomlyselected to be subrogated to establish the modified pool, to reducesystematic sampling errors, as is understandable. Next, sampler 144samples a peer group from the modified pool. One reason for sampling apeer group from the modified pool is to save system resources ofcomputer system 100 (FIG. 2), for example, the memory space required forfurther calculation. It should be understood that in some situations,sampling may not be necessary or may not be desirable. For example, ifthe modified pool itself is not big or if the potential sampling errorsare not acceptable, the modified pool itself may be used as the peergroup. The sampling may use any now known or future developed methods ofsampling, for example, random sampling or representative sampling.

Next in step S202 b, behavioral attribute identifier 145 identifies aset of claim attributes regarding which target claim 16, if it hassubrogation potential, is expected to include similar behavior as thepeer group identified in step S202 a. The identified set of claimattributes is referred to as behavioral attributes, for illustrativepurpose only. For a specific target claim 16, it may not be expectedthat it includes similar behaviors regarding all claim attributes as thepeer group, if it has subrogation potential, instead it may be expectedthat target claim 16 includes similar behaviors regarding some claimattributes as the peer group. In addition, even if target claim 16 isexpected to include similar behaviors regarding all claim attributes,not all claim attributes are of concern for target claim 16 in aspecific evaluation.

According to one embodiment, the selection of behavioral attributes maybe based on statistical analysis of the peer group behaviors regardingclaim attributes. For example, a standard deviation of the peer groupbehaviors regarding a specific claim attribute may be compared to athreshold, for example, standard deviation being less than 10 percent ofmean. If the standard deviation of the peer group behaviors regarding aspecific claim attribute meets the threshold, that specific claimattribute may be selected as a behavioral attribute.

According to an alternative embodiment, the selection of behavioralattributes may be based on identified “contributing” claim attributesthat are related to claim subrogation potential. For example, if basedon past records, it is established that a set of claim attributes, forexample, in the case of fire damage in a house, time between loss andsubmission of claim and actions taken after accident to reduce furtherloss are related to (contributing to) the outcomes of claim subrogationprocesses, this set of claim attributes may be selected, among others,as the behavioral attributes. For another example, in the case of caraccident, location of accident, time between accident and report toinsurer, amount of loss, whether a third part was involved, whether apolice report was filed, whether claimant 16 was at fault, and number ofparties involved may be selected, among others, as the behavioralattributes. It should be noted that any now known or later developedmethods of selecting behavior attributes are also included in thecurrent invention and may be used independently, or in combination, inselecting behavioral attributes.

Please note, step S202 b is not necessarily conducted after step S202 a.According to an alternative embodiment, claim subrogation potentialevaluating system 132 may identifies the behavioral attributes beforeselecting a peer group. In this situation, the selection of peer groupmay be based on a similarity between and among target claim 16 and otherclaims 16 with respect to claim attributes other than the set ofbehavioral attributes.

According to one embodiment, behavioral attribute data and thesubrogation result data may be arranged in a table. FIG. 5 shows anillustrative example of the data table of an illustrative peer group ofcar accident claims. Referring now to FIG. 5, as is understandable, in asubrogation process, more than one subrogation solution may be tried.For example, for a car accident claim (16), investigating units 14(FIG. 1) may attempt to identify the manufacturer of the cars involvedas responsible for the claimed loss (SUB_Manu), or may attempt toidentify another driver as negligence in causing the accident(SUB_Driver). If a responsible third party is identified through atleast one of the subrogation solutions, claim 16 is consideredsuccessfully subrogated. Subrogation results may be indicated by binarycodes. For example, as shown in FIG. 5, value “1” may be used toindicate a positive subrogation result, e.g., successfully identifies aresponsible third party, and value “0” may be used to indicate anegative subrogation result, e.g., no third party is identified asresponsible.

Next in step S202 c, analyzer 146 determines a normal behavior of thepeer group selected in step S202 a, regarding the set of behavioralattributes identified in step S202 b. In step S202 c, analyzer 146 mayalso determines a relationship between the identified behavioralattributes to the outcomes of subrogation.

Various methods may be used to determine the normal behavior. Accordingto one embodiment, the average of the behaviors of the peer groupregarding a behavioral attribute may be selected as the normal behaviorregarding this behavioral attribute. The average of the peer group maybe either the mean or the median depending on a specific target claim 16and a specific evaluation. According to one embodiment, the mean of thebehaviors of the peer group of claims 16 is a better choice to be usedas the normal behavior because a standard deviation is calculated basedon the mean, instead of the median. As will be described below, astandard deviation may be used in further analysis, such as a scorenormalization procedure. It should be noted that any now existing andlater developed methods of determining a normal behavior are included inthe scope of the present invention.

According to one embodiment, the relationship between a behavioralattribute and an outcome of subrogation may be determined by determininga statistical relationship between a specific subrogation solution andthe behavioral attribute, such as a correlation or a regressionequation. For example, using the example of data table shown in FIG. 5,the relationship between behavioral attribute “time from accident toreport” to subrogation outcomes may be determined by determine acorrelation between “time from accident to report” and “Sub_Manu” andbetween “time from accident to report” to “Sub_Driver”. It should benoted that any now known and later developed methods of determining arelationship between a behavioral attribute and subrogation solutionsare all included in the present invention.

Please be noted, step S202 does not need to be conducted after computersystem 100 receives/collects all the data regarding target claim 16.Instead, step S202 may be conducted any time before. For example, aninsurance company employing processing center 12 may established a peergroup based on its own classification of claims and obtain the normalbehavior and the relationship between behavior attributes andsubrogation solutions before claim subrogation potential evaluatingsystem 132 is operated to evaluate the subrogation potential of targetclaim 16. For example, the peer group and normal behavior may beestablished during system setup, and may be saved in database 128 forfuture reference.

It should be also noted, the procedure of the determination of therelationship between a behavioral attribute and a subrogation solutionmay also be used to select a behavioral attribute. For example, arelationship between a claim attribute and a subrogation solution may beused to determine whether the claim attribute can be selected as abehavioral attribute. If it is determined that the claim attribute isrelated to the outcome of the subrogation solution, e.g., a correlationexists, the behavioral attribute can be selected as a behavioralattribute.

Next in step S203, subrogation potential evaluator 148 evaluates asubrogation potential of target claim 16. Specifically, in step S203 a,comparator 150 compares the behavior of target claim 16 with the normalbehavior determined in step S202 regarding each of the identified set ofbehavioral attributes. The specific procedure of the comparison dependson how the normal behavior is determined in step S202 c. According toone embodiment, if the normal behavior is determined using the mean ofthe peer group behaviors regarding each identified behavioral attribute,comparator 150 compares the behavior of target claim 16 with the normalbehavior with respect to each of the identified set of behavioralattributes. The difference between the behavior of target claim 16 andthe normal behavior with respect to each behavioral attribute may beconverted into a 0 to 1000 score, in a manner that a bigger differenceis converted to a higher score. It should be noted that any scorenormalization procedures (methods) may be used in the conversion and isincluded in the current invention. Because the details regarding theconversion are not necessary for an understanding of the currentinvention, no further details will be provided.

Next in step S203 b, combiner 152 combines the comparison results, i.e.,the scores, with respect to each behavioral attribute to generate anoverall comparison result, i.e., a combined score. A low combined scoreindicates that target claim 16 conforms to the norm, which predicts thattarget claim 16 has the potential of subrogation. Please note, the peergroup is selected from claims 16 that have been successfully subrogatedand the normal behavior is the norm of claims that have subrogationpotential. The combined score may be compared to a threshold todetermine whether target claim 16 has the potential to be subrogated. Ifthe combined score is lower than the threshold, i.e., meets thethreshold, target 16 is considered having subrogation potential andcomputer system 100 will communicate the result to claim subrogationimplementation unit 200 to implement a subrogation process (FIG. 1).

According to one embodiment, the combined scores of more than one targetclaims 16 may be ranked in a list of claims waiting for subrogation.Claim 16 with lowest combined score, i.e., highest subrogationpotential, is put on the top of the list. Due to limited resources, aninsurance company may not subrogate all of the target claims 16, butwill select claims 16 to be subrogated from the top of the list.

According to one embodiment, the combined score is obtained by averagingthe scores obtained regarding each individual behavioral attributes.According to an alternative embodiment, the score with respect to abehavioral attribute is first weighed according to the behavioralattribute's relative importance in evaluating subrogation potentialbefore the score is combined with others to obtain a combined score.

In addition, an individual score regarding an individual behavioralattribute may also be used to evaluate whether target claim 16 has thepotential to be subrogated for a specific subrogation solution, if thebehavioral attribute has been determined as related to the specificsubrogation solution, in step S202 c.

The results of the evaluation, e.g., the combined scores and theindividual scores may be communicated to, for example, claim subrogationimplementation unit 200 (FIG. 1) though, for example, evaluation resultsoutputs 166. In addition, if the operation of claim subrogationpotential evaluating system 132 is provided as a service to a customerinsurance company, the results of the evaluation, e.g., the individualand the combined scores, may be communicated to the customer insurancecompany through, e.g., evaluation results outputs 166.

With respect to the prospective analysis, according to the embodimentshown in FIG. 3, step S300 includes two steps S301 and S302. Pleasenote, step S300 occurs before all claim attribute data of target claim16 have been collected. As such, according to one embodiment, theprospective analysis operation only evaluates target claim 16 regardingindividual behavioral attributes, but not their combination. Inaddition, results of the historic analysis, e.g., the peer group and thenormal behaviors, may be used as a basis for the prospective analysis.

Specifically, in step S301, suspect behavior detector 154 detects asuspect behavior of a target claim 16. According to one embodiment,suspect behavior detector 154 compares the behavior of target claim 16to the normal behavior regarding the behavioral attributes identified instep S202, using the available data of target claim 16. If thecomparison shows that target claim 16 includes an suspect behavior,i.e., a behavior similar to the normal behavior, regarding at least onebehavioral attribute, which predicts subrogation potential, theprospective analysis will proceed to step S302. If the comparison showsthat target claim 16 does not include a suspect behavior regarding anyof the behavioral attributes, based on the available information,prospective analysis will pause to wait for more information regardingtarget claim 16.

Next in step S302, prospective subrogation potential investigator 156instructs investigating units 14 (FIG. 1) to investigate target claim 16purposefully regarding subrogation potential. For example, if in stepS301, target claim 16 is determined to include a suspect behaviorregarding a specific behavioral attribute that has been determined instep S202 c of the historic analysis to be related to a specificsubrogation solution, prospective subrogation potential investigator 156may instruct investigating units 14 to pay more attention to investigatethe potential of the specific subrogation solution. For another example,if in step S301, target claim 16 is determined to include a suspectbehavior regarding a specific behavioral attribute that has not beendetermined in step S202 c of the historic analysis to be related to anyspecific subrogation solution, prospective subrogation potentialinvestigator 156 may instruct investigating units 14 to pay generallymore attention to investigate subrogation potential.

Please note, in the description of the operation of claim subrogationpotential evaluating system 132, the historic analysis (step S200) isdiscussed before the prospective analysis (step S300). This order ofdescription is used only for illustrative purpose because theprospective analysis is based on the peer group and the normal behaviordetermined in the historic analysis. However, for the processing of aspecific target claim 16 (FIG. 1), the prospective analysis may occurbefore the historic analysis. For example, in a computer system 100, thepeer group and the normal behavior of the historic analysis may havealready been established (through, e.g., a previous historic analysisoperations or a system setup) and are saved in database 128 (FIG. 2).Regarding a specific target claim 16, claim subrogation potentialevaluating system 132 may first begin a prospective analysis usingavailable information regarding target claim 16 and may iterate theprospective analysis as more information is collected until all theinformation required for a historic analysis is collected, whenevaluating system 132 may begin and complete the historic analysis.

4. Conclusion

While shown and described herein as a method and system for evaluating asubrogation potential of an insurance claim, it is understood that theinvention further provides various alternative embodiments. For example,in one embodiment, the invention provides a program product stored on acomputer-readable medium, which when executed, enables a computerinfrastructure to evaluate a subrogation potential of an insuranceclaim. To this extent, the computer-readable medium includes programcode, such as claim subrogation potential evaluating system 132 (FIG.2), which implements the process described herein. It is understood thatthe term “computer-readable medium” comprises one or more of any type ofphysical embodiment of the program code. In particular, thecomputer-readable medium can comprise program code embodied on one ormore portable storage articles of manufacture (e.g., a compact disc, amagnetic disk, a tape, etc.), on one or more data storage portions of acomputing device, such as memory 120 (FIG. 2) and/or database 128 (FIG.2), and/or as a data signal traveling over a network (e.g., during awired/wireless electronic distribution of the program product).

In another embodiment, the invention provides a method of generating asystem for evaluating a subrogation potential of an insurance claim. Inthis case, a computer infrastructure, such as computer system 100 (FIG.2), can be obtained (e.g., created, maintained, having made availableto, etc.) and one or more systems for performing the process describedherein can be obtained (e.g., created, purchased, used, modified, etc.)and deployed to the computer infrastructure. To this extent, thedeployment of each system can comprise one or more of: (1) installingprogram code on a computing device, such as computing system 100 (FIG.2), from a computer-readable medium; (2) adding one or more computingdevices to the computer infrastructure; and (3) incorporating and/ormodifying one or more existing systems of the computer infrastructure,to enable the computer infrastructure to perform the process steps ofthe invention.

In still another embodiment, the invention provides a business methodthat performs the process described herein on a subscription,advertising supported, and/or fee basis. That is, a service providercould offer to evaluate a subrogation potential of an insurance claim asdescribed herein. In this case, the service provider can manage (e.g.,create, maintain, support, etc.) a computer infrastructure, such ascomputer system 100 (FIG. 2), that performs the process described hereinfor one or more customers and communicates the results of the evaluationto the one or more customers. In return, the service provider canreceive payment from the customer(s) under a subscription and/or feeagreement and/or the service provider can receive payment from the saleof advertising to one or more third parties.

As used herein, it is understood that the terms “program code” and“computer program code” are synonymous and mean any expression, in anylanguage, code or notation, of a set of instructions that cause acomputing device having an information processing capability to performa particular function either directly or after any combination of thefollowing: (a) conversion to another language, code or notation; (b)reproduction in a different material form; and/or (c) decompression. Tothis extent, program code can be embodied as one or more types ofprogram products, such as an application/software program, componentsoftware/a library of functions, an operating system, a basic I/Osystem/driver for a particular computing and/or I/O device, and thelike. Further, it is understood that the terms “component” and “system”are synonymous as used herein and represent any combination of hardwareand/or software capable of performing some function(s).

The flowcharts and block diagrams in the Figures illustrate thearchitecture, functionality, and operation of possible implementationsof systems, methods and computer program products according to variousembodiments of the present invention. In this regard, each block in theflowchart or block diagrams may represent a module, segment, or portionof code, which comprises one or more executable instructions forimplementing the specified logical function(s). It should also be notedthat, in some alternative implementations, the functions noted in theblocks may occur out of the order noted in the figures. For example, twoblocks shown in succession may, in fact, be executed substantiallyconcurrently, or the blocks may sometimes be executed in the reverseorder, depending upon the functionality involved. It will also be notedthat each block of the block diagrams and/or flowchart illustration, andcombinations of blocks in the block diagrams and/or flowchartillustration, can be implemented by special purpose hardware-basedsystems which perform the specified functions or acts, or combinationsof special purpose hardware and computer instructions.

The terminology used herein is for the purpose of describing particularembodiments only and is not intended to be limiting of the invention. Asused herein, the singular forms “a”, “an” and “the” are intended toinclude the plural forms as well, unless the context clearly indicatesotherwise. It will be further understood that the terms “comprises”and/or “comprising,” when used in this specification, specify thepresence of stated features, integers, steps, operations, elements,and/or components, but do not preclude the presence or addition of oneor more other features, integers, steps, operations, elements,components, and/or groups thereof.

Although specific embodiments have been illustrated and describedherein, those of ordinary skill in the art appreciate that anyarrangement which is calculated to achieve the same purpose may besubstituted for the specific embodiments shown and that the inventionhas other applications in other environments. This application isintended to cover any adaptations or variations of the presentinvention. The following claims are in no way intended to limit thescope of the invention to the specific embodiments described herein.

1. A method for evaluating a subrogation potential of a target claim forinsurance payment, the method comprising steps of: selecting a peergroup of claims that are expected to include a similar behavior as thetarget claim and have been successfully subrogated; identifying a set ofbehavioral attributes of the peer group; determining a normal behaviorof the peer group regarding the identified set of behavioral attributes;and comparing a behavior of the target claim to the normal behaviorregarding the identified set of behavior attributes to evaluate thesubrogation potential of the target claim.
 2. The method of claim 1,wherein the normal behavior determining step includes collectingbehaviors of the peer group and analyzing the collected behaviors of thepeer group regarding the identified set of behavioral attributes.
 3. Themethod of claim 1, wherein the comparing step includes steps of:comparing the behavior of the target claim with the normal behavior withrespect to each of the identified set of behavioral attributes; andcombining a result of the comparison with respect to each of theidentified set of behavioral attributes to generate an overallcomparison result.
 4. The method of claim 1, wherein the peer groupselecting step includes a step of determining a similarity between andamong the target claim and other claims for insurance payment withrespect to claim attributes other than the set of behavioral attributes.5. The method of claim 1, further including a step of prospectivelyinvestigating the subrogation potential based on a result of thecomparing step.
 6. A system for evaluating a subrogation potential of atarget claim for insurance payment, the system comprising: means forselecting a peer group of claims that are expected to include a similarbehavior as the target claim and have been successfully subrogated;means for identifying a set of behavioral attributes of the peer group;means for determining a normal behavior of the peer group regarding theidentified set of behavioral attributes; and means for comparing abehavior of the target claim to the normal behavior regarding theidentified set of behavior attributes to evaluate the subrogationpotential of the target claim.
 7. The system of claim 6, furtherincluding: means for collecting behaviors of the peer group; and meansfor analyzing the collected behaviors of the peer group regarding theidentified set of behavioral attributes.
 8. The system of claim 6,further including: means for comparing the behavior of the target claimwith the normal behavior with respect to each of the identified set ofbehavioral attributes; and means for combining a result of thecomparison with respect to each of the identified set of behavioralattributes to generate an overall comparison result.
 9. The system ofclaim 6, wherein the peer group selecting includes determining asimilarity between and among the target claim and other claims forinsurance payment with respect to claim attributes other than the set ofbehavioral attributes.
 10. The system of claim 6, further includingmeans for prospectively instructing an investigation the subrogationpotential based on a result of the behavior comparing.
 11. A computerprogram product for evaluating a subrogation potential of a target claimfor insurance payment, the computer program product comprising: computerusable program code configured to: select a peer group of claims thatare expected to include a similar behavior as the target claim and havebeen successfully subrogated; identify a set of behavioral attributes ofthe peer group; determine a normal behavior of the peer group regardingthe identified set of behavioral attributes; and compare a behavior ofthe target claim to the normal behavior regarding the identified set ofbehavior attributes to evaluate the subrogation potential of the targetclaim.
 12. The program product of claim 11, wherein the program code isfurther configured to collect data of behaviors of the peer group andanalyze the collected behavior data of the peer group regarding theidentified set of behavioral attributes.
 13. The program product ofclaim 11, wherein the program code is further configured to: compare thebehavior of the target claim with the normal behavior with respect toeach of the identified set of behavioral attributes; and combine aresult of the comparison with respect to each of the identified set ofbehavioral attributes to generate an overall comparison result.
 14. Theprogram product of claim 11, wherein the program code is furtherconfigured to determine a similarity between and among the target claimand other claims for insurance payment with respect to claim attributesother than the set of behavioral attributes.
 15. The program product ofclaim 11, wherein the program code is further configured toprospectively instruct an investigation of the subrogation potentialbased on a result of the behavior comparison.
 16. A method of generatinga system for evaluating a subrogation potential of a target claim forinsurance payment, the method comprising: providing a computerinfrastructure operable to: select a peer group of claims that areexpected to include a similar behavior as the target claim and have beensuccessfully subrogated; identify a set of behavioral attributes of thepeer group; determine a normal behavior of the peer group regarding theidentified set of behavioral attributes; compare a behavior of thetarget claim to the normal behavior regarding the identified set ofbehavior attributes to evaluate the subrogation potential of the targetclaim; and communicate a result of the evaluation to a customerinsurance company.
 17. The method of claim 16, wherein computerinfrastructure is further operable to collect data of behaviors of thepeer group and analyze the collected behavior data of the peer groupregarding the identified set of behavioral attributes.
 18. The method ofclaim 16, wherein computer infrastructure is further operable to:compare the behavior of the target claim with the normal behavior withrespect to each of the identified set of behavioral attributes; andcombine a result of the comparison with respect to each of theidentified set of behavioral attributes to generate an overallcomparison result.
 19. The method of claim 16, wherein computerinfrastructure is further operable to determine a similarity between andamong the target claim and other claims for insurance payment withrespect to claim attributes other than the set of behavioral attributes.20. The method of claim 16, wherein computer infrastructure is furtheroperable to prospectively instruct an investigation of the subrogationpotential based on a result of the behavior comparison.